Provider Demographics
NPI:1497526230
Name:SOUTH BAY LA THERAPY: A PROFESSIONAL CLINICAL COUNSELOR CORPORATION
Entity Type:Organization
Organization Name:SOUTH BAY LA THERAPY: A PROFESSIONAL CLINICAL COUNSELOR CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:310-291-7837
Mailing Address - Street 1:24520 HAWTHORNE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6844
Mailing Address - Country:US
Mailing Address - Phone:310-291-7837
Mailing Address - Fax:
Practice Address - Street 1:24520 HAWTHORNE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6844
Practice Address - Country:US
Practice Address - Phone:310-291-7837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty